Yoko Murata

Endoscopic ultrasonography of the upper gastrointestinal tract

SummaryEndoscopic ultrasonography was used for assessment of the extent of tumour invasion of the upper gastrointestinal (GI) tract, including analysis of submucosal tumour and detection of lymph-node metastasis. The normal oesophageal and gastric wall was depicted as five layers by endoscopic ultrasonography (EUS). The outer layer invaded by cancer was defined as the depth of tumour invasion. In 173 cases of oesophageal cancer, the depth of cancer invasion was diagnosed correctly in 88%. In 146 cases of gastric cancer, it was diagnosed correctly in 79%. In submucosal tumours of the GI tract, the site of tumour in the wall was diagnosed correctly in 99% and the histological type of tumour was predicted. EUS can also be used to detect small lymph nodes. According to the criteria, used in this study, EUS had a sensitivity of 84%, a specificity of 88% and an overall accuracy of 88% for detection of lymphnode metastases.

Evaluation of endoscopic ultrasonography for the diagnosis of submucosal tumors of the esophagus

SummaryEndoscopic ultrasonography was carried out on 55 patients whose X-ray films or endoscopic examinations indicated the presence of a submucosal tumor. Endoscopic ultrasonography revealed 8 cases of extraluminal compression and 48 cases of submucosal tumors. Histological studies were performed on 29 cases with submucosal tumors. In 28 of the 29 cases (97%) the location of the tumor in the esophageal wall was correctly estimated ultrasonographically, and appropriate treatment was selected. Tumors ranging from 3 to 50 mm in diameter could be measured accurately. This method may be helpful in follow-up studies. Endoscopic ultrasonographic findings, such as characteristics of the tumor border and internal echoes, were studied to predict the histological diagnosis of the tumor. Leiomyoma, cyst, granular cell tumor, lipoma, and intraluminal metastasis of esophageal cancer were all found to have specific ultrasonographic findings indicating the histological nature of the tumor.

The Capability of Three Dimensional Display during Endoscopic Ultrasonography

Abstract: Endoscopic ultrasonography (EUS) has been found to be useful in determining the depth of invasion of gastric cancer, the diagnosis of submucosal tumors and extramural compressions. A problem with this procedure is that it is difficult to determine stereoscopically the relative position of the lesion as a whole, even though EUS may be an excellent diagnostic tool for determining tomographies. In this paper, we made three‐dimensional displays of EUS images using a personal computer to facilitate understanding of the relative anatomical positions of the lesions. During EUS examination, the distance from the incisors was acccurately measured, and the EUS image was recorded on U‐matic tape. To measure the distance from the incisors, we devised a new instrument for measuring the endoscopic insertion length. The recorded tape was edited for input into the computer. The soft‐ware for the three‐dimensional display program was made by Photoron. Inc. A patient with esophageal cancer, a patient with a common bile duct stone and a patient with pancreatic cancer are presented as examples for definition of the relationship with the surrounding organs. A patient with a gastric ulcer is used as an example to clarify the pathological structure of the lesions. Using our method on these patients, it was easy to obtain a stereograph and to obtain complete images of the lesions. EUS was available for three ‐dimensional displays of the lesions in the gastrointestinal tract and in the surrounding area, and this has clinical significance.

Liver resection for HER2-enriched breast cancer metastasis: case report and review of the literature

Liver metastasis from breast cancer usually results in the development of systemic metastasis. We report a breast cancer patient with an early isolated liver recurrence who survived more than 7xa0years with no recurrence. She was treated with aggressive HER2-directed chemotherapy and hepatic metastasectomy. Local hepatectomy with effective medical oncological therapy with curative intent is worth trying in patients with breast cancer liver metastasis.

Diagnosis and Treatment of the Inoperable Esophagus Carcinoma

Taking many factors into consideration, indication for surgery of esophageal cancer is rather difficult to establish. It is of importance to assess invasion to the adventitia.Diagnosis of stage A3, utilizing X-ray, CT and endoscopic ultrasonography, is discussed. It is possible to get an eighty percent correct diagnosis by the X-ray findings such as the depth of ulceration and the characteristics of the surrounding rim of the tumor besides an esophagotracheal fistula and a clear penetration.Furthermore, it is possible to observe the relationship of the esophagus to the trachea and the aorta by using an endoscopic ultrasonography and a CT scan.However, since even these examinations have demerits, a doctors intuition and sensitivity plays an important part.The treatment of the cases, in which a resection is inadvisable or impossible, is also discussed.